Bed Bugs

This patient wonders whether the insect he found on his headboard might be responsible for the clusters of pruritic, crusted papules on his legs. This turned out to be a bed bug.

A 41-year-old man presented with several clusters of pruritic, crusted papules on his legs. He asserts that these appear overnight. He wonders if the “bug” he found on his headboard might be responsible.

Key point: Occasionally patients will bring in specimens for examination to determine whether the organisms are responsible for “bites” or other skin conditions (such as hives). In this instance, the rounded shape, flattened body, and size (about 5 mm) of this brown, 6-legged insect are all classic features for a bedbug. These insects are nocturnal blood feeders, which is why the patient noticed new lesions in the morning.

Treatment: Application of any low-potency corticosteroid, such as 2.5% hydrocortisone or 0.05% desonide cream, will lead to prompt symptomatic relief.

Note: The patient will need professional exterminator assistance, because these insects are particularly difficult to completely eradicate.